Articles

Volume-3, 2022
Issue 6 (Jun)



Melatonin treatment of delirious state: A case study

Melatonin secretion decreases with age and in neurodegenerative diseases like Alzheimer's Disease (AD). Sundown syndrome ("sundowning"), characterized by agitation, wandering, anxiety, aggression and confusion in the evening and at night is prevalent among demented patients.

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Three-vessel spontaneous coronary artery dissection: A case report

The patient was a 42-years-old vegan man, without any risk factor for atherosclerosis, admitted with the diagnosis of non-ST segment elevation myocardial infarction after a common cold. Coronary angiography revealed three-vessel Spontaneous Coronary Artery Dissection (SCAD) in diagonal, obtuse marginal and right coronary artery extending to posterior left ventricular artery.

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A rare case report: Giant cell tumor of the presacral space and itís management

Giant Cell Tumor (GCT) is a rare primary skeletal lesion accounting for approximately 5% of all primary bone tumors in adults. GCT has been described histologically as a benign neoplastic lesion. It clinically presents as painless, firm, well defined mass without any fixity to underling structures. Although it is benign in nature but rarely GCT may exhibit a much more aggressive phenotype.

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Cutaneous Mucormycosis in a kidney transplant patient: A case report

Mucormycosis is a fungal disease that evolves rapidly and is associated with a high risk of morbidity and mortality in immunodepressed patients, and which requires multidisciplinary medical and surgical approach. Invasive Fungal Infections (IFIs) is still a diagnostic and therapeutic issue.

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Inflammatory myofibroblastic tumor of the orbital floor: A case report

Inflammatory myofibroblastic tumors are rare benign tumors of unknown etiology. Initially described in the lungs, they have been observed in several other locations, mainly abdominal and pelvic. Cervicofacial localization is very rare and orbital localization is exceptional. We report the case of inflammatory myofibroblastic tumor localized on the floor of the orbit in a 45 years old patient.

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Forgotten double J stent with maximum stone burden

The Double J stent, or DJ stent, is a self-retaining ureteral stent that is widely used in urologic practice. The primary goal of the DJ stent is to enable adequate kidney drainage into the urinary bladder. However, because of widespread use, lack of patient education, or due to a lack of adherence to regular follow-up, patients may end up with a forgotten DJ stent, which can stay undiagnosed in the pelvi-ureteral system for years and cause a lot of complications before coming to attention.

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Abernethy malformation

A 59-years-old woman presented to the emergency department with sudden onset of intermittent hematemesis and melena. The patient had a history of stage IV cervical cancer, sigmoid colostomy (because of rectovaginal fistula). A complete blood count showed normocytic anemia (79 g/l) and other laboratory evaluation showed the elevation of ammonia (38 ?mol/l).

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Kikuchi Fujimoto disease: A rare case of recurrence

Kikuchi-Fujimoto's Disease (KFD) is rare, benign and more frequent in Asia. It is characterized by the appearance of lymphadenopathies and fever. Histological examination of the lymph nodes make the diagnosis. It is a self-limited disease. Relapses rarely occur. We described a case in Europe, with the particularity of having presented recurrence.

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An unusual cause of abdominal bloating

Bloating is a common symptom reported in Gastroenterology clinics. A 37-year old man presented with history of abdominal bloating and increased frequency of stools for two months which was not relieved with pro-kinetic drugs or proton pump inhibitors. His physical examination was unremarkable. Lab tests and abdominal USG were normal.

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Choroidal melanoma in the setting of nevus of ota

The patient is a 56 years old female who presented to the office with a complaint of blurry vision OS for a few weeks. Upon initial encounter, several pigmented macules were visible around the left eye and on the lids. The patient mentioned she had these lesions since birth.

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Technical challenges to a successful valve-in-valve Transcatheter Mitral Valve Implantation (TMVI)

Mitral valve disease is more common than Aortic valve stenosis in the developing world. Surgical approach has remained the gold standard in management of degenerative and failed bioprosthetic Mitral Valve Regurgitation (MR). However, with the success of Transcatheter Aortic Valve Implantations (TAVI), the percutaneous replacement of a diseased Mitral Valve (MV) is also becoming a viable option in select patients.

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Challenges in the diagnosis and management of Cushingís disease: A case series

Cushing disease is considered as a rare condition characterized by the increases secretion of the Adrenocorticotropic Hormone (ACTH) due to a pituitary adenoma that ultimately causes endogenous hypercortisolism state by stimulating the adrenal glands. Cushing disease is associated with many complications like short stature, weight gain, osteoporosis, cardiovascular and respiratory disorder which leads to high rates of morbidity and mortality.

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Diabetes management in spinal surgery

Diabetes mellitus can lead to long-standing complications in multiple arenas. An area that is often overlooked is implications for major surgery. Spinal decompression and fusions have unique challenges in the diabetic patient. In this review, we briefly highlight the pathophysiology of diabetes mellitus prior to examining implications for spinal surgery. We focus on the wound healing process, surgical infection risk, and delayed fusion.

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Long term follow-up of vitamin D dependent rickets type IA caused by novel mutation in cyp27b1 in a 2.5 years old Pakistani boy: A case report

Rickets usually caused by deficiency of vitamin D and itís a condition which affects bone development and leads to softening and weakling of bones in children. But there are rare inherited problems reported which leads to rickets and these are, Vitamin D Dependent Rickets Type 1, Vitamin D Dependent Rickets Type 2 (also known as Vitamin D resistant rickets) and 25 hydroxylase deficiency rickets.

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Clostridium difficile and helicobacter pylori co-infection

A 64 year old male patient presented with ulcerative colitis exacerbation along with dyspepsia, nausea and weight loss. He was found to have stool Clostridium Difficilis toxin test positive and H.Pylori stool antigen positive. It is rare to have both of these infections in the same patient and there is no guideline on management of this co infection.

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Acute intestinal spirochetosis presenting as an IBD mimicker

25-year-old male with a history of polysubstance abuse (cocaine and crystal meth) and risky sexual behavior, who presented with a 1-month history of intermittent hematochezia, loose stools and lower abdominal pain. ROS revealed subjective fevers, night sweats, and chills for the preceding 4 days. He used intra-rectal cocaine and crystal meth injection with a needleless syringe.

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A rare triad of fractures in the upper limb. Simultaneous fractures of the distal radius

Weíre reporting a 35-year-old gentleman that presented with a rare combination of ipsilateral fracture of both proximal and distal ends of the radius associated with ulna styloid fracture due to a fall with outstretched hands. Thorough clinical examination of two adjacent joints (elbow and wrist) is critical in identifying such an unusual or rare combination of injuries.

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A rare cause of small bowel bleeding

We present a rare cause of gastrointestinal bleeding resulting from fistulae between the mesenteric artery and portal venous system, caused as a late complication of sleeve gastrectomy. A high index of suspicion, based upon venous engorgement without an occluding thrombus, enabled prompt diagnosis and occlusion of the fistulae with coils, leading to marked clinical improvement.

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Brown sequard syndrome as a manifestation of acute spontaneous spinal haematoma: A diagnostic challenge

Brown-Sequard Syndrome (BSS) is a neurological disorder caused by hemisection lesion of the spinal cord. BSS causes can be dichotomized in traumatic and atraumatic, and they can include vascular causes, as ischemia or haemorrhage. We describe the case of a 52-year-old woman presenting with limbs paraesthesia and right leg hyposthenia, associated with cervical acute nontraumatic pain (C6-C7 level).

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A cutaneous nodule in the gluteal region revealing an anal fistula

A 32-year-old female patient, primiparous, with no particular pathological history, presented a painful cutaneous nodule located at the perianal level of the left buttock evolving since her delivery 3 years ago, and through which seropurulent fluid flows intermittently. The symptomatology evolved in a context of apyrexia and conservation of the general state.

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Intestinal resection via perineal in a patient with recurrent perineal hernia

We present the case of a 69-year-old woman diagnosed with neoplasia of the midrectum, requiring abdominoperineal amputation in 2016, and repair of a perineal hernia observed during follow-up in 2018, with placement of a Ventralex-type mesh. Consultation in 2019 for suspected recurrence of perineal hernia confirmed by MRI.

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Overview of Covid-19 vaccine hesitancy in low-and-middle income countries (LMICs)

The unfolding of SARS CoV-2 from China and its outbreak around the world has caused chaos globally. The need to control this deadly virus led to the immediate development of the COVID vaccine, which had risen doubts among the population about its utilization. Therefore, vaccine hesitancy has major repercussions for the success of vaccine initiatives and is a threat to acquiring herd immunity; this paper discusses the level of Covid-19 vaccine hesitancy in LMICs.

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A leaking food pipe: Bronchoesophageal fistula secondary to lung cancer

A 58-year-old female with advanced lung cancer, hypertension, hyperlipidemia, pulmonary artery thrombosis, bilateral subclavian artery stenosis, and vocal cord dysfunction presented to the ER with cough, shortness of breath, dysphagia, and weight loss. HR 114 bpm, RR 24/min, SpO2 95% on 4L, Temperature 36.2oC. She was lethargic, chronically ill-looking, and had bronchial breath sounds and crackles in the right upper lobe.

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Aortic regurgitation in rheumatoid arthritis: A case report

Recent epidemiological studies have reported an increase in cardiovascular morbidity and mortality in Rheumatoid Arthritis (RA). The most common cardiac involvement in RA is pericarditis, followed by myocarditis, coronary vasculitis, then aortitis. However, valvular heart disease has been rarely reported especially the aortic one.

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Cerebrovascular malformations in adults: What mode of revelation? About 53 cases

Cerebrovascular malformations include a broad spectrum of intracranial blood vessel disorders, involving the arterial wall, capillary bed, venous and lymphatic systems. Their main associated risks are intracerebral hemorrhage, seizures and focal neurological deficits. We carried out a retroprospective study over a period of 45 months (3 years and 9 months), ranging from April 01, 2018 to December 31, 2021.

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Covid-19 in pregnancy: A case series of complexities and challenges in management, pregnancy outcome and review of literature at Northampton General Hospital UK

To describe the complexities and challenges in managing very complex and fascinating cases of Covid-19 in pregnancy at a district hospital in the UK. A 44-year-old African lady, G6P0+5 dichorionic diamniotic IVF twins, BMI 28kg/m2, complex medical history (essential hypertension, non-functioning pituitary macro-adenoma, partial hypopituitarism leading to diabetes insipidus, hypothyroidism, low cortisol, previous myomectomy, laparoscopies.

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Gastric pneumatosis: An unexpected complication in multiple myeloma patient

Gastric pneumatosis is an unusual and rare condition with unclear management recommendations. We report a case of gastric pneumatosis in an adult patient with multiple myeloma on chemotherapy with concomitant fungemia. Patient presented with right lower abdominal pain and subsequently developed spinal cord compression and got treated with high dose dexamethasone and chemotherapy.

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Atlantoaxial subluxation of the C1/C2 vertebrae in the pediatric patient: A case study

A nine-year-old male presenting with neck pain and head tilt was referred for neurosurgical evaluation. According to the referring pediatrician, the head tilt and torticollis had persisted for the previous three weeks. Of note, a prodromal upper respiratory viral illness was reported, with erythema of the left mastoid area that had resolved after a few days of conservative management.

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Rare recurrent solitary plexiform neurofibroma of the dorsum of the finger: A case report

Plexiform neurofibroma (PN) is a subtype of neurofibroma that is rather uncommon in the clinic. Plexiform neurofibroma is usually associated with neurofibromatosis type I (NF1). Only very few patients have isolated PN, which means they have neither NF1 signs nor relevant family history. Solitary PN is extremely rare. There have been no instances of finger back PN or solitary PN all around the world, which could lead to misdiagnosis, missed diagnosis, and mistreatment.

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Assessment of corneal topographic patterns and densitometric parameters in patients with severe delayed-onset mustard gas keratopathy and patients suffered from corneal scarring

This study was performed to evaluate the densitometric values and the type of corneal topographic pattern extracted from Pentacam HR (OCULUS, Wetzlar, Germany) in two groups of severe delayed-onset mustard gas keratopathy (DMGK) and old herpes simplex corneal scarring. Twenty eyes of each group were enrolled to the study and were examined using the Pentacam HR.

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Post covid thromboembolic catastrophe: Any management readdressal needed in covid era?

COVID-19 predisposes to a hyper-coagulable state. Thromboembolic sequelae of COVID-19 might be the first presentation of the disease. A raised titer of anti-SARS-CoV-2 antibodies might suggest an underlying pro-thrombotic milieu secondary to post-COVID status. The present case report cites a 29-year-old obese male presenting with acute pulmonary embolism and right atrium to right ventricle thrombus in transit diagnosed to be post-COVID on the basis of raised anti-SARS-CoV-2 antibodies.

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Unilateral blindness following elective nasal septoplasty

To report a case of unilateral blindness following nasal septoplasty. A 38 years old man, who referred to ophthalmology service one day after nasal septoplasty. He complained of vision loss in his right eye and right eye lids swelling and ecchymosis. The paranasal and orbital computed tomography scan revealed direct traumatic lesion to medial part of optic nerve in orbital apex.

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Double edge sword

Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitides (AAVs) are characterized blood vessel inflammation and necrosis which may lead to diffuse alveolar hemorrhage (DAH) resulting in life threatening respiratory failure. We present a case of microscopic polyangiitis presented in respiratory failure secondary to DAH that developed a rare treatment related complication.

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A case of hemorrhagic septicemia in pasteurellosis

The patient (DH 8993), a mail, 17 years old, a resident of the rural district of the Zhambyl region of Kazakhstan, participated in the cutting and butchering of farm animals. He became acutely ill on 2.12.21 (1 day of illness), - the temperature increased (up to 38), headache, weakness appeared, appetite decreased. There was vomiting.

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Robotic adrenalectomy for adrenal pseudocyst: Case report and review of literature

Adrenal cysts are uncommon lesions that are usually benign, with an incidence of 0.06-0.18%. Pseudocysts are the second most common type of adrenal cyst. We present the case of a 57-year-old female whose CT scan of the abdomen incidentally revealed a 7.2 cm right adrenal tumor with peripheral calcifications. Due to its large size and unusual CT findings, resection was indicated.

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MELAS exhibiting multiple mass enhancement and dural enhancement: Case report

MELAS is maternally-inherited encephalomyopathy, characterized by seizures, migrainous headaches, lactic acidosis, vomiting, and recurrent stroke-like episodes. The strokes are affecting mainly the cerebral cortex and can be visualized by MRI. Most of the reported cases in the literature present with no enhancement or slight enhancement on MRI enhanced scan, but exhibiting multiple nodular enhancement and dural enhancement has never been reported.

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Fahr syndrome presenting with epileptic seizure: A rare case report

Fahrís syndrome is a rare neurodegenerative disorder characterized by abnormal symmetrical calcifications of the basal ganglia, thalami, subcortical hemispheric white matter and deep cerebellar nuclei. The most common clinical presentations are movement disorders, pyramidal signs, parkinsonism, gait disorders, cerebellar anormalities, psychotic symptoms and cognitive disorders. This article discusses rare presentation of Fahrís syndrome with epileptic seizure.

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Monosomy 18p and trisomy 17q in a boy with unilateral absence of the right pulmonary artery

Unilateral absence of the pulmonary artery (UAPA) is an infrequent finding, with an estimated prevalence of 1 in 200,000 young adults. The percentage of syndromic UAPA is not known but mostly does not have a syndromic association, only being reported with the 22q11 deletion syndrome. We present the case of a baby boy with peculiar facies and UAPA, who developed severe bilateral pulmonary fibrosis.

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Role of mitomycin-C to reduce post FESS adhesion and ostial stenosis

The aim of this study is to determine adhesion formation rate and antrostomy closure rate after the use of Mitomycin-C in patients underwent FESS. This is a prospective case control study conducted at ENT Department Lyari General Hospital, Karachi, Pakistan. Fifty one patients included with diagnosis of bilateral chronic rhinosinusitis or allergic fungal sinusitis and were the surgical candidate, underwent bilateral Functional Endoscopic Sinus Surgery (FESS).

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Late rectal hematoma after stapled hemorrhoidopexy: A case report

Intestinal wall hematoma can occur after a blunt abdominal trauma or can be a spontaneous event. Spontaneous intramural rectal hematomas are rare but can occur in patients taking anticoagulant therapy or with hematologic disorders and associated blood clotting disorders. We present a case of a spontaneous symptomatic rectal wall hematoma occurred 10 years after a stapled hemorrhoidopexy which was successfully treated with non-operative management.

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A sign of love from the thyroid

A 41-year-old woman presented to our office, around valentineís day, complaining of cervical discomfort. On physical examination, a midline cervical mass was identified. A cervical ultrasonography (Figure 1a and 1b) showed a heart shaped hypoechogenic colloidal cyst (3.4 X 3.5 X 3.5 cm) in her left thyroid lobe containing a hyperechogenic heart shaped colloidal aggregation.

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Relevance intraoperative diagnosis of fibrous pseudotumor para testicular: Challenge for sparing testis

A paratesticular fibrous pseudotumor is a relatively rare benign disease. Preoperatively diagnosing a fibrous pseudotumor is challenging because distinguishing these masses from malignant tumors on the basis of clinical and radiological findings is difficult to see impossible. We present a case of a 34-year-old man who presented with a 2-year history of right testicular swelling and was advised right radical orchidectomy by another surgeon.

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Octreotide scintigraphy mimicking whole body bone scan

The patient is a 70-year-old man presented with dyspepsia, abdominal pain, nausea, vomiting and bone pain more severe in ribs, pelvis and lower extremities. Immunohistochemistry assay revealed positive Ki67 of the liver metastases [5]. Abdominal ultrasound revealed multiple hyperechoic lesions in the liver that the largest one was 57 mm X 49 mm.

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Macroglossia and amyloid deposition of the tongue

Amyloidosis encompasses a group of disorders involving extracellular deposition of an abnormally folded protein. Light chain amyloidosis is a common type of systemic amyloidosis and is typically associated with an underlying plasma cell neoplasm. Here we describe an uncommon presentation of light chain amyloidosis.

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Raw oyster consumption causing vibrio vulnificus bacteremia in ESRD patient

Vibrio is gram negative bacteria found in warm salty water. Vibrio vulnificus is one of the most common species causing vibriosis in the United States. It is associated with primary sepsis, skin infections as well as gastrointestinal tract infection. Here we present a case of Vibrio vulnificus bacteremia in a hemodialysis dependent ESRD patient.

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